Alterações dentárias em crianças com microcefalia associada à Síndrome Congênita do Zika Vírus e outras infecções congênitas / Dental changes in children with microcephaly associated with Congenital Zika Virus Syndrome and other congenital infections

As consequências da microcefalia associada à Síndrome Congênita do Zika Vírus (SCZ) e outras infecções congênitas no desenvolvimento dentário da criança afetada ainda não são bem conhecidas. Os objetivos deste estudo foram avaliar a frequência de alterações dentárias em crianças com microcefalia, analisar se há associação das alterações dentárias com a SCZ e verificar se a microcefalia é fator de risco para as alterações dentárias. Para isso, foram realizados dois estudos observacionais transversais e um estudo do tipo caso-controle. Um único examinador calibrado (Kappa > 0,8) avaliou a presença de alterações dentárias de número, forma e tamanho, alterações na cronologia e sequência de irrupção dentária e alterações no desenvolvimento do esmalte dentário em crianças com microcefalia, associada à SCZ e outras infecções congênitas, e em crianças normoreativas. Informações relacionadas à gestação da mãe e ao nascimento da criança foram coletadas e um questionário socioeconômico foi aplicado. Os dados foram avaliados descritivamente e, como testes de associação, foram utilizados o teste do Qui-quadrado e Exato de Fisher, considerando um nível de significância de 5% (estudos 2 e 3). A amostra do primeiro estudo foi composta por 49 crianças entre 7 e 35 meses de idade apresentando microcefalia associada à SCZ. As alterações mais prevalentes foram as relacionadas à cronologia de irrupção (93,9%; IC95%= 89­99%), às alterações no desenvolvimento do esmalte dentário (76,1%; IC95%= 64­88%) e sequência de irrupção dentária (71,7%; IC95%= 60­84%). No segundo estudo, 62 crianças, com idade entre 7 e 35 meses, portadoras de microcefalia associada à SCZ e outras infecções congênitas compuseram a amostra. Não houve associação estatisticamente significativa entre a SCZ e a presença de alteração na cronologia (p = 1,00) e sequência de irrupção dentária (p = 0,16) e de desenvolvimento do esmalte dentário (p = 1,00). No estudo de caso-controle, 81 crianças entre 30 e 35 meses de idade, normoreativas e portadoras de microcefalia, fizeram parte da amostra, a qual, após identificadas as frequências de cada uma das alterações dentárias, foi emparelhada pelo sexo e idade, na proporção 1:1, e alocadas nos grupos caso (presença de alterações dentárias) e controle (ausência de alterações dentárias). A presença de microcefalia mostrou-se estatisticamente associada ao atraso na irrupção dentária (p < 0,001), à presença de alterações na sequência de irrupção dentária (p < 0,001) e de defeitos no esmalte dentário (p < 0,001). Concluiu-se que as crianças com microcefalia associada à SCZ apresentaram atraso na irrupção dentária, alterações na sequência irruptiva e opacidade do esmalte dos dentes decíduos, no entanto, a infecção pelo vírus Zika não foi associada à ocorrência dessas alterações dentárias. A microcefalia, independente de sua etiologia, é fator de risco para alterações relacionadas ao processo de irrupção dentária e ao desenvolvimento do esmalte dos dentes decíduos (AU).

The consequences of microcephaly associated with Congenital Zika Virus Syndrome (CZS) and other congenital infections on the dental development of the affected child are not well known. The objectives of this study were to evaluate the frequency of dental alterations in children with microcephaly, to analyze if there is an association of dental alterations with CZS, and to verify if microcephaly is a risk factor for dental alterations. For this, two crosssectional observational studies and one case-control study were performed. A single calibrated examiner (Kappa > 0,8) evaluated the presence of dental alterations of number, shape and size, alterations in the chronology and sequence of tooth eruption, and alterations in the tooth enamel development in children with CZS and other congenital infections, as well as in normoreactive children. Information related to mothers' pregnancies and child births were collected and a socioeconomic questionnaire was applied. Data were descriptively evaluated and chi-square test and Fisher's exact test were used as association tests considering a significance level of 5% (studies 2 and 3). The first study sample consisted of 49 children between 7 and 35 months of age with CZS-associated microcephaly. The most prevalent alterations were related to the eruption chronology (93.9%), changes in the development of the enamel (76.1%) and the dental eruption sequence (71.7%). Next, 62 children aged 7 to 35 months with CZS-associated microcephaly and other congenital infections comprised the sample in the second study. There was no statistically significant association between CZS and the presence of changes in chronology (p = 1.00), sequence of tooth eruption (p = 0.16) and tooth enamel development (p = 1.00). In the case-control study, 81 normoreactive children and children with microcephaly between 30 and 35 months of age were part of the sample, which were then paired by gender and age at a 1:1 ratio after identifying the frequencies of each of the dental alterations, and then allocated to the case (presence of dental changes) or control (absence of dental changes) groups. The presence of microcephaly was statistically associated with delayed tooth eruption (p<0.001), the presence of changes in tooth eruption sequence (p<0.001) and dental enamel defects (p<0.001). It was concluded that children with CZS-associated microcephaly had delayed dental eruption, alterations in the eruptive sequence and hypomineralization of primary tooth enamel; however, a Zika virus infection was not associated with these dental changes. A microcephaly, regardless of its etiology, is a risk factor for changes related to the tooth eruption process and the development of primary tooth enamel. It is concluded that microcephaly associated with CZS and other congenital infections is a risk factor for delayed tooth eruption, alterations in the eruptive sequence and defects in dental enamel development occurring (AU).

Quality of life of patients with cleft lip and / or cleft palate: perspective of parents/guardians

To evaluate the quality of life of children with oral cleft.Material and Methods:The ECOHIS questionnaire was used to assess the quality of life of 31 patients aged 02-05 years from the perception of their parents. Study's variables were divided into impact on children subscale, through the domain of symptoms, limitations, psychological and self-image; and impact on the family subscale, through the domain anguish of parents and family function. Descriptive analysis tests were used in Statistical Software Program -SPSS® version 18.0.Results:71% of sample subjects were male.There was prevalence of cleft lip -palate (38.7%), followed by cleft lip (32.3%) and cleft palate (29%). Cleft transforamen incisive (38.7%) was predominantand the most frequent location was unilateral left (58.3%) and the complete type was the most significant (75%). All participants mentioned some impact of the problem on the child's quality of life. In the impact on children subscale, limitations domain had the highest average (mean: 5.16; SD2.87) and in the impact on family subscale, family function domain was the most significant (mean: 2.29; SD: 1.82). As for difficulties faced by children, question on "difficulty in pronouncing words" was the most significant (61.3%). Conclusion:The presence of clefts impacts the quality of life of children and their families, thus requiring strategies for the reestablishment of aesthetics, function and psychological support for such individuals...